06 February 2020
Today is Time to Talk Day, a day dedicated to encouraging people to be more open about their mental health – to talk and listen. You can find more information about Time to Talk Day here. Here, our Policy Officer Margaret Gould talks about the impact of mental and physical health in rheumatology and our recommendations.
Mental and physical health are closely linked, and neglect of one can impact on the other. However, people using health services often find their physical and mental health needs are addressed in a disconnected way.
People with long-term conditions are 2-3 times more likely to experience mental health problems. The stress of diagnosis, living with symptoms, and the wider impacts on their work, social and family lives can affect people’s mental health.
For a bit of context, 80% of people with arthritis feel anxious and depressed because of their condition and half feel isolated and lonely due to their arthritis. But these issues often don’t come up in a consultation as patients are far more likely to voice physical symptoms. Frequently, healthcare professionals don’t ask patients about their mental health. A NRAS survey found only 40% of patients with RA or AJIA had ever been asked about emotional and psychological wellbeing by a health professional.
How do you integrate mental and physical health services?
Our recently released ‘Rheumatology and mental health’ factsheet examines the relationship between mental health and MSK conditions. In it we recommend the integration of mental and physical health, by providing more psychological support in rheumatology departments and increasing training for primary and secondary care health professionals on mental health and holistic assessments.
Clinical psychologists in departments and clinics
Some rheumatology departments do have psychology services integrated into their departments. The NEIAA found that 39% of trusts in England and Wales have psychology available in rheumatology departments, and we found these numbers to be quite similar in paediatric and adolescent rheumatology departments as well. This may mean that the department has a clinical psychologist within their MDT.
One of our shortlisted Best Practice applicants from Alder Hey NHS Foundation Trust established an MDT clinic with clinical psychology, physiotherapy and occupational therapy for children and young people with chronic pain. This allowed them to have their physical and psychological needs assessed within one clinic appointment.
Ideally, clinical psychologists could be embedded within all rheumatology MDTs, but with current clinical psychology workforce numbers, this seems highly unlikely.
Upskilling Specialist nurses and AHPs
There are other ways of integrating psychology support into departments that rely on existing workforce; for instance, there are opportunities for primary and secondary care professionals to upskill by undertaking training in mental health. Questions about mental and emotional wellbeing can be incorporated into existing clinics, while specialist nurses and other allied health professionals can be upskilled to provide one-to-one or group-based psychological interventions.
However, with clinic times already tight and many departments under-resourced, are we asking too much of our rheumatology workforce?